**Background:** Celiac disease (CD) requires lifelong adherence to a gluten-free diet (GFD), but the long-term effects of GFD on cardio-metabolic risk factors, particularly lipid profile, are unclear. Processed gluten-free (GF) products often have higher saturated fat content and glycemic index compared to naturally GF foods, which may adversely affect blood lipids and glucose. This study aimed to evaluate changes in lipid profile and glycemia in prepubertal celiac children on different GFD regimens after at least 1 year of remission.
**Methods:** This retrospective study analyzed data from 15 prepubertal celiac patients (8 female, 7 male) followed at the Gastroenterology Unit, University of Chieti, Italy. Inclusion criteria: first lipid profile assessment (time_1) between 1–3 years of GFD, good compliance (negative IgA-TG2), and second assessment (time_2) within 5 years of GFD. Patients with comorbidities (type 1 diabetes, thyroid disease, juvenile idiopathic arthritis) were excluded. Patients were divided into two groups: group 1 (n=8) consumed ≥4 processed GF products/day; group 2 (n=7) consumed <2 processed GF products/day, preferring naturally GF foods. Anthropometric measures (height, weight, BMI, SBP, DBP) and laboratory values (total cholesterol [TC], LDL-C, HDL-C, triglycerides [TG], glycemia) were collected at both timepoints. Variables were expressed as Standard Deviation Scores (SDS). Wilcoxon test compared time_1 vs. time_2; Mann-Whitney test compared groups. Significance set at p<0.05.
**Key Results:** At time_1, median age was 7.23±1.79 years; at time_2, 8.62±2.02 years. Mean years on GFD at time_1 was 2.44±0.42; at time_2, 3.86±0.68. No significant differences in SDS-BMI were found between timepoints for the whole group or subgroups. SDS-SBP and SDS-DBP increased significantly overall (SDS-SBP: –0.19±1.03 to 0.26±0.97, p=0.01; SDS-DBP: –0.025±0.69 to 0.42±0.62, p=0.019). In group 1 (processed GF), SDS-DBP increased significantly (p=0.004), but not in group 2. For lipid profile, overall SDS-LDL-C increased significantly from –1.08±0.6 to –0.51±1.14 (p=0.017), and glycemia from 74.4±5.47 to 79±5.77 mg/dL (p=0.014). No significant changes were seen in SDS-TC, SDS-HDL-C, SDS-TG, or TG/HDL ratio overall. In group 1, SDS-TC increased from –0.88±0.73 to –0.32±0.85 (p=0.001), SDS-LDL-C from –0.93±0.53 to –0.11±0.8 (p=0.001), and glycemia from 74.33±6.65 to 79±5.81 (p=0.009). In group 2, no significant changes were observed. At time_2, TC and LDL-C were significantly different between groups.
**Clinical Implications:** This study suggests that in prepubertal celiac children in remission, consumption of processed GF products is associated with unfavorable changes in lipid profile (increased TC, LDL-C) and fasting glycemia, independent of BMI changes. These alterations were not seen in children consuming naturally GF foods. Given the short observation period and prepubertal status, these findings raise concern about long-term cardiovascular risk. The authors recommend dietary supervision by a dietitian, preference for naturally GF foods, and regular monitoring of lipid profile in celiac children on GFD. Limitations include small sample size (n=15) and retrospective design, but the highly selected population (remission, prepubertal, good compliance) strengthens the validity.